Department of Neurology, UKD and Center for Neurology and Neuropsychiatry, LVR Klinikum, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
Department of Neurology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic.
Curr Opin Neurol. 2019 Jun;32(3):327-337. doi: 10.1097/WCO.0000000000000699.
The purpose of this review is to describe the new 2017 revisions of the McDonald diagnostic criteria for multiple sclerosis and review first experiences in their application to different patient populations.
The 2017 revisions agreed on by an international expert panel, as the precursors, define criteria needed to fulfill dissemination in time and space in the clinically isolated syndrome after exclusion of alternative diagnoses. One major change is the inclusion of cerebrospinal fluid (CSF) oligoclonal bands as evidence of dissemination in time in a patient with dissemination in space gathered by clinical or magnetic resonance examination. The distinction between asymptomatic and symptomatic lesions in counting for evidence of dissemination in space or time in supra, infratentorial, and spinal cord syndrome has been abandoned. Finally, cortical lesions can be used to demonstrate dissemination in space. Major differential diagnoses, in particular, the still-evolving concept of neuromyelitis optica spectrum disorders and the myelin oligodendrocyte glycoprotein-IgG-related demyelinating central nervous system disorders.
The new 2017 revisions will simplify the application of the MRI criteria for dissemination in space and include CSF findings as evidence for dissemination in time in clinically isolated syndrome.
本次综述旨在描述多发性硬化症的新 2017 年修订版诊断标准，并回顾其在不同患者人群中应用的初步经验。
国际专家组作为前身达成的 2017 年修订版，定义了在排除其他诊断后，临床孤立综合征中时间和空间传播所必需的标准。一个主要变化是将脑脊液（CSF）寡克隆带纳入时间传播的证据，以补充通过临床或磁共振检查收集的空间传播证据。在计算空间或时间传播的证据时，已不再区分无症状和有症状病变，用于上、下脑和脊髓综合征。最后，可以使用皮质病变来证明空间传播。主要鉴别诊断，特别是神经髓鞘炎视神经光谱障碍和髓鞘少突胶质细胞糖蛋白-IgG 相关脱髓鞘中枢神经系统障碍的概念仍在不断发展。
新的 2017 年修订版将简化空间传播 MRI 标准的应用，并将 CSF 结果纳入临床孤立综合征中时间传播的证据。
